Healthcare Provider Details

I. General information

NPI: 1275665119
Provider Name (Legal Business Name): ELIZABETH ANN GRASSE RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 RUFFIN CT
SAN DIEGO CA
92123-5300
US

IV. Provider business mailing address

3225 NEWELL STREET UNIT #3
SAN DIEGO CA
92106
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-4719
  • Fax:
Mailing address:
  • Phone: 619-225-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number300075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number300075
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number300075
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number300075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: